Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation

A single-center experience in Japan

Y. Kanda, S. Mineishi, T. Saito, S. Seo, A. Saito, K. Suenaga, M. Ohnishi, H. Niiya, K. Nakai, T. Takeuchi, N. Kawahigashi, N. Shoji, T. Ogasawara, Ryuji Tanosaki, Y. Kobayashi, K. Tobinai, M. Kami, S. Mori, R. Suzuki, H. Kunitoh & 1 others Y. Takaue

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

From April 1998 to March 2000, a cytomegalovirus (CMV) antigenemia-guided pre-emptive approach for CMV disease was evaluated in 77 adult patients who received allogeneic hematopoietic stem cell transplantation at the National Cancer Center Hospital. A CMV antigenemia assay was performed at least once a week after engraftment. High-level antigenemia was defined as a positive result with 10 or more positive cells per 50 000 cells and low-level antigenemia was defined as less than 10 positive cells. Among the 74 patients with initial engraftment, 51 developed positive antigenemia. Transplantation from alternative donors and the development of grade II-IV GVHD were independent risk factors for positive antigenemia. Ganciclovir was administered as pre-emptive therapy in 39 patients in a risk-adapted manner. None of the nine low-risk patients with low-level antigenemia as their initial positive result developed high-level antigenemia even though ganciclovir was withheld. Only one patient developed early CMV disease (hepatitis) during the study period. CMV antigenemia resolved in all but two cases, in whom ganciclovir was replaced with foscarnet. In eight patients, however, the neutrophil count decreased to 0.5 × 109/1 or less after starting ganciclovir, including three with documented infections and two with subsequent secondary graft failure. The total amount of ganciclovir and possibly the duration of high-dose ganciclovir might affect the incidence of neutropenia. We concluded that antigenemia-guided pre-emptive therapy with a decreased dose of ganciclovir and response-oriented dose adjustment might be appropriate to decrease the toxicity of ganciclovir without increasing the risk of CMV disease.

Original languageEnglish
Pages (from-to)437-444
Number of pages8
JournalBone Marrow Transplantation
Volume27
Issue number4
DOIs
Publication statusPublished - 2001
Externally publishedYes

Fingerprint

Ganciclovir
Hematopoietic Stem Cell Transplantation
Cytomegalovirus
Japan
Therapeutics
Foscarnet
Cancer Care Facilities
Neutropenia
Hepatitis
Neutrophils
Transplantation
Tissue Donors
Transplants
Incidence
Infection

Keywords

  • Antigenemia
  • Cytomegalovirus
  • Ganciclovir
  • Hematopoietic stem cell transplantation
  • Pre-emptive therapy

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation : A single-center experience in Japan. / Kanda, Y.; Mineishi, S.; Saito, T.; Seo, S.; Saito, A.; Suenaga, K.; Ohnishi, M.; Niiya, H.; Nakai, K.; Takeuchi, T.; Kawahigashi, N.; Shoji, N.; Ogasawara, T.; Tanosaki, Ryuji; Kobayashi, Y.; Tobinai, K.; Kami, M.; Mori, S.; Suzuki, R.; Kunitoh, H.; Takaue, Y.

In: Bone Marrow Transplantation, Vol. 27, No. 4, 2001, p. 437-444.

Research output: Contribution to journalArticle

Kanda, Y, Mineishi, S, Saito, T, Seo, S, Saito, A, Suenaga, K, Ohnishi, M, Niiya, H, Nakai, K, Takeuchi, T, Kawahigashi, N, Shoji, N, Ogasawara, T, Tanosaki, R, Kobayashi, Y, Tobinai, K, Kami, M, Mori, S, Suzuki, R, Kunitoh, H & Takaue, Y 2001, 'Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: A single-center experience in Japan', Bone Marrow Transplantation, vol. 27, no. 4, pp. 437-444. https://doi.org/10.1038/sj.bmt.1702805
Kanda, Y. ; Mineishi, S. ; Saito, T. ; Seo, S. ; Saito, A. ; Suenaga, K. ; Ohnishi, M. ; Niiya, H. ; Nakai, K. ; Takeuchi, T. ; Kawahigashi, N. ; Shoji, N. ; Ogasawara, T. ; Tanosaki, Ryuji ; Kobayashi, Y. ; Tobinai, K. ; Kami, M. ; Mori, S. ; Suzuki, R. ; Kunitoh, H. ; Takaue, Y. / Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation : A single-center experience in Japan. In: Bone Marrow Transplantation. 2001 ; Vol. 27, No. 4. pp. 437-444.
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AU - Kami, M.

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AU - Suzuki, R.

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